Chapter 4

Acute care

- Assessments focus on information related to patient's self-care needs and self-care deficits for managing an ongoing illness. The nurse needs to focus assessment questions on the patient's self-care needs that can be met within an acute care setting, with the goal of providing interventions to support self-care and discharge of the patient back to home.

Community-based

- Assessments focus on information related to the patient's self-care needs and self-care deficits in order to provide for health promotion and disease prevention within the community. There may be patients in the community setting who need self-care for management of an existing illness such as arthritis or asthma. The nurse needs to assess the factors within a patient's living situation that support or interfere with his or her self-care ability.

As an art nursing relies on knowledge gained from practice and reflection on past experiences. As a science nursing relies on (select all that apply): 1. Experimental research. 2. Nonexperimental research. 3. Research from other disciplines. 4. Professional opinions.

Answer: 1, 2, 3. Rationale: As a science, nursing relies on knowledge gained through research from nursing and other disciplines and scientifically tested knowledge applied in the practice setting.

While working in a community health clinic, it is important to obtain nursing histories and get to know the patients. Part of history taking is to develop the nurse-patient relationship. Which of the following apply to Peplau's theory when establishing the nurse-patient relationship? (Select all that apply.) 1. An interaction between the nurse and patient must develop. 2. The patient's needs must be clarified and described. 3. The nurse-patient relationship is influenced by patient and nurse preconceptions. 4. The nurse-patient relationship is influenced only by the nurse's preconceptions.

Answer: 1, 2, 3. Rationale: There is continual interaction by both the patient and the nurse throughout all phases of the nurse-patient relationship. Option 4 is incorrect because the focus is only on the nurse.

Jennifer knows that ____________ describe phenomena, speculate on why they occur, and describe their consequences.

Answer: descriptive theories Rationale: Descriptive theories are the first level of theory development that describe phenomena, speculate on why they occur, and describe their consequences.

Case Study: Jennifer is a first-semester nursing student who is studying the theoretical foundations of nursing practice. She learns that nursing theory is the foundation of nursing research, which builds the scientific knowledge base of nursing that is applied to practice. As more research is conducted, the discipline learns to what extent a given theory is useful in providing information to improve patient care. Once Jennifer completes nursing school, she plans to obtain her master's degree in nursing research. Therefore Jennifer is interested in learning how components in a theory help drive research questions to improve nursing.

Chapter 4

Kathy Jones and Sheri Walker are sophomores in a college program. Next week they will have their first clinical practice. Kathy will be in a community health setting, and Sheri will be in an acute health care agency. They need to prepare general assessment questions applicable to both settings using Orem's self-care deficit theory. Explain how the theory might apply for patient assessment in different health care settings. a. Acute care b. Community-based care

a. Acute care: Assessments focus on information related to patient's self-care needs and self-care deficits for managing an ongoing illness. The nurse needs to focus assessment questions on the patient's self-care needs that can be met within an acute care setting, with the goal of providing interventions to support self-care and discharge of the patient back to home. b. Community-based: Assessments focus on information related to the patient's self-care needs and self-care deficits in order to provide for health promotion and disease prevention within the community. There may be patients in the community setting who need self-care for management of an existing illness such as arthritis or asthma. The nurse needs to assess the factors within a patient's living situation that support or interfere with his or her self-care ability.

In a classroom setting you are given the following examples of questions that lead either to theory-generating or theory-testing research. Identify whether they are theory testing or theory generating and explain.

a. Theory testing: The interventions are designed to test a prescribed exercise program to enhance weaning from a ventilator. b. Theory generating: The investigator wants to know what patients remember from weaning from a mechanical ventilator. This information gives the investigator some description of what the phenomenon of being on a ventilator means, helping to generate a theory.

Theory testing

- The interventions are designed to test a prescribed exercise program to enhance weaning from a ventilator.

Theory generating

- The investigator wants to know what patients remember from weaning from a mechanical ventilator. This information gives the investigator some description of what the phenomenon of being on a ventilator means, helping to generate a theory.

A nurse is applying Henderson's theory as a basis for theory based-nursing practice. Which other elements are important for theory-based nursing practice? (Select all that apply.) 1. Knowledge of nursing science 2. Knowledge of related sciences 3. Knowledge about current health care issues 4. Knowledge of standards of practice

Answer: 1, 2, 4. Rationale: Regardless of which particular nursing theory is selected, the nurse must use knowledge from nursing and related sciences, experience, and standards of practice when providing care.

Which of the following statements apply to theory generation? (Select all that apply.) 1. Builds scientific knowledge base of nursing 2. Discovers relationships of phenomena to practice 3. Tests specific phenomena 4. Identifies observations about a phenomenon

Answer: 1, 2, 4. Rationale: Theory-generating research identifies observations or describes phenomena. It contributes to the scientific knowledge base of nursing. Relationships of the phenomena to practice and testing specific phenomena are part of the theory-testing research activities.

Jennifer learns about the focus of nursing theories. Nursing theories focus on the ___________ of nursing and nursing care.

Answer: phenomenon Rationale: A phenomenon is the term, description, or label given to describe an idea or responses about an event, a situation, a process, a group of events, or a group of situations. The phenomenon of nursing and nursing care is the focus of nursing theories.

Match the following theories with their definitions. 1. Grand theory 2. Middle-range theory 3. Descriptive theory 4. Prescriptive theory A. Addresses specific phenomena and reflect practice B. First level in theory development and describes a phenomenon C. Provides a structural framework for broad concepts about nursing D. Linked to outcomes (consequences of specific nursing interventions)

Answer: 1, C; 2, A; 3, B; 4, D. Rationale: A grand theory is systematic and broad in scope and provides a structural framework for nursing practice. A middle-range theory focuses on a specific field or phenomenon rather than the broad scope of nursing. A descriptive theory is the first level of theory development and describes the phenomena under study. A prescriptive theory details nursing interventions for a specific phenomenon and the expected outcome of the care. These theories help guide research.

Match the following components of systems theory with the definition of that component. 1. Feedback 2. Input 3. Content 4. Output A. Data entering the system B. End product C. Data related to system functioning D. Product and information obtained from the system

Answer: 1, C; 2, A; 3, D; 4, B. Rationale: A system functions on its content, input, output and feedback. The components are interrelated and share a common purpose to form a whole; there is a continuous process of input, output, and feedback data.

Which of the following is closely aligned with Leininger's theory? 1. Caring for patients from unique cultures 2. Understanding the humanistic aspects of life 3. Variables affecting a patient's response to a stressor 4. Caring for patients who cannot adapt to internal and external environmental demands

Answer: 1. Rationale: Leininger's theory of transcultural nursing focuses on the patient's culture and the impact of culture heritage on health care needs and interventions.

Which of the following theories describe the life processes of an older adult facing chronic illness? 1. Systems theories 2. Developmental theories 3. Interdisciplinary theories 4. Health and wellness models

Answer: 2. Rationale: Developmental theories describe and predict behavior and development at various phases of the life continuum, as in the phase of older adulthood.

A patient with diabetes is controlling the disease with insulin and diet. The nursing health care provider is focusing efforts to teach the patient self-management. Which of the following nursing theories is useful in promoting self management? 1. Neuman 2. Orem 3. Roy 4. Peplau

Answer: 2. Rationale: Orem's theory of self-care provides a solid theoretical background for self-management for a variety of diseases. This theory shows the nurse how to direct the patient toward self-management to promote health and/or sustain wellness.

A patient is admitted to an acute care area. The patient is an active business man who is worried about getting back to work. He has had severe diarrhea and vomiting for the last week. He is weak, and his breathing is labored. Using Maslow's hierarchy of needs, identify this patient's immediate priority. 1. Self-actualization 2. Air, water, and nutrition 3. Safety 4. Esteem and self-esteem needs

Answer: 2. Rationale: The immediate priority is air, water, and nutrition. The patient needs to have sufficient air exchange, which might require oxygen administration. In addition the patient needs to have appropriate fluid balance and some nutritional supplement.

A theory is a set of concepts, definitions, relationships, and assumptions that: 1. Formulate legislation. 2. Explain a phenomenon. 3. Measure nursing functions. 4. Reflect the domain of nursing practice.

Answer: 2. Rationale: Theories are designed to explain a phenomenon such as self-care or caring. A theory is a way of seeing through a "set of relatively concrete and specific concepts" and the propositions that describe or link the concepts.

To practice in today's health care environment, nurses need a strong scientific knowledge base from nursing and other disciplines such as the physical, social, and behavioral sciences. This statement identifies the need for which of the following? 1. Systems theories 2. Developmental theories 3. Interdisciplinary theories 4. Health and wellness models

Answer: 3. Rationale: As the health system evolves and the health care needs of the patient focus on health promotion, illness prevention, and treatment, more disciplines are involved in patient care. To be effective in practice nurses need to be aware of theoretical approaches of care arising from other disciplines and from nursing.

Which of the following statements about theory-based nursing practice is incorrect? 1. Contributes to evidence-based practice 2. Provides a systematic process for designing nursing interventions 3. Is not linked to nursing outcomes 4. Guides the nurse's assessment

Answer: 3. Rationale: Theory-based nursing practice does reflect nursing outcomes. For example, prescriptive theories address specific nursing interventions and predict the patient response.

Which of the following are components of the paradigm of nursing? 1. The person, health, environment, and theory 2. Health, theory, concepts, and environment 3. Nurses, physicians, health, and patient needs 4. The person, health, environment/situation, and nursing

Answer: 4. Rationale: The nursing paradigm focuses on person, health, environment/situation, and nursing. All the elements interact with one another, with the patient being central.

Theory-based nursing practice uses a theoretical approach for nursing care. This approach moves nursing forward as a science. This suggests that: 1. One theory will guide nursing practice. 2. Scientists will decide nursing decisions. 3. Nursing will only base patient care on the practice of other sciences. 4. Theories will be tested to describe or predict patient outcomes.

Answer: 4. Rationale: There are multiple theories for the practice of nursing; these theories are tested to develop the evidence to describe or predict patient outcomes.

Jennifer learns the difference between internal and external patient factors. Which of the following is an example of an external factor that affects the patient? (Select all that apply.) A. Change in health care policy B. Increase in health insurance premium C. Change in cognitive function D. Increase in respiratory rate

Answer: A, B Rationale: External factors exist outside the patient system (e.g., such as a change in health care policy and an increase in health insurance premium). Internal factors exist within the patient system (e.g., physiological and behavioral responses to illnesses). Change in cognitive function and increase in respiratory rate are examples of internal factors.

Building Competency in Patient-Centered Care You are working with a college freshman who is 20% overweight when compared to national growth and weight ratios. The student seeks help in the University's student health clinic and wants to be part of the solution. She asks you to help design a program to help her lose weight, improve her nutrition, and increase her activity level. Her goal is to lose at least 10% of her body weight by the end of the school year. Using Orem's theory, what assessment data will you need to help her manage her weight loss and nutritional and activity status?

Answer: Ask what she considers to be her strengths regarding changing her eating and exercise habits. Determine her usual daily food intake and activity levels. Determine why she eats what she does and why she has her current activity level. Assess her understanding of how her diet impacts on her current weight. Ask her to identify what she thinks will work for her regarding designing an activity pattern. Determine how independent she wants to and can be in this process (Table 4-1).

Chapter 4: Key Points

• A nursing theory is a conceptualization of some aspect of nursing communicated for the purpose of describing, explaining, predicting, and/or prescribing nursing care. • Grand theories are the complex structural framework for broad, abstract ideas. • Middle-range theories are more limited in scope and less abstract. These theories address specific phenomena or concepts and reflect practice. • The paradigm of nursing identifies four links of interest to the profession: the person, health, environment/situation, and nursing. Nurse theorists agree that these four components are essential to the development of theory. • Theory is the generation of nursing knowledge used for practice. Nursing process is the method for applying the theory or knowledge. The integration of theory and nursing process is the basis for professional nursing. • Theories from nursing and other disciplines help explain how the roles and actions of nurses fit together in nursing. • Theory-generating research tries to discover and describe relationships without imposing preconceived notions (e.g., hypotheses) of what the phenomenon under study means. • Theory-testing research determines how accurately a theory describes nursing phenomena.